Racial differences in the outcome of patients with urothelial carcinoma of the upper urinary tract: an international study

• Published in: BJU international Vol. 108; no. 8b; pp. E304 - E309
• Main Authors: Matsumoto, Kazumasa, Novara, Giacomo, Gupta, Amit, Margulis, Vitaly, Walton, Thomas J., Roscigno, Marco, Ng, Casey, Kikuchi, Eiji, Zigeuner, Richard, Kassouf, Wassim, Fritsche, Hans‐Martin, Ficarra, Vincenzo, Martignoni, Guido, Tritschler, Stefan, Rodriguez, Joaquin Carballido, Seitz, Christian, Weizer, Alon, Remzi, Mesut, Raman, Jay D., Bolenz, Christian, Bensalah, Karim, Koppie, Theresa M., Karakiewicz, Pierre I., Wood, Christopher G., Montorsi, Francesco, Iwamura, Masatsugu, Shariat, Shahrokh F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2011; Wiley Subscription Services, Inc; Wiley
• Subjects: Aged; Asian Continental Ancestry Group; Bioengineering; Carcinoma, Transitional Cell; Carcinoma, Transitional Cell - surgery; Drug therapy; Ethnicity; European Continental Ancestry Group; Female; Human health and pathology; Humans; Japan; Kidney Neoplasms; Kidney Neoplasms - surgery; Life Sciences; Male; Middle Aged; nephroureterectomy; prognosis; race; recurrence; Regression analysis; Retrospective Studies; Treatment Outcome; Ureteral Neoplasms; Ureteral Neoplasms - surgery; urinary tract cancer; Urogenital system; Urology and Nephrology; urothelial carcinoma; Japan; recurrence; urinary tract cancer; urothelial carcinoma; race; nephroureterectomy; prognosis
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10188.x

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The differential effect of ethnicity on clinico‐pathological features and cancer‐related outcomes remains uninvestigated in upper tract urothelial carcinoma. Ethnicity was not an independent predictor of either recurrence or cancer‐related death in upper tract urothelial carcinoma. OBJECTIVE • To assess the impact of differences in ethnicity on clinico‐pathological characteristics and outcomes of patients with upper urinary tract urothelial carcinoma (UTUC) in a large multi‐center series of patients treated with radical nephroureterectomy (RNU). MATERIALS AND METHODS • We retrospectively collected the data of 2163 patients treated with RNU at 20 academic centres in America, Asia, and Europe. • Univariable and multivariable Cox regression models addressed recurrence‐free survival (RFS) and cancer‐specific survival (CSS). RESULTS • In all, 1794 (83%) patients were Caucasian and 369 (17%) were Japanese. All the main clinical and pathological features were significantly different between the two ethnicities. • The median follow‐up of the whole cohort was 36 months. At last follow‐up, 554 patients (26%) developed disease recurrence and 461 (21%) were dead from UTUC. • The 5‐year RFS and CSS estimates were 71.5% and 74.2%, respectively, for Caucasian patients compared with 68.8% and 75.4%, respectively, for Japanese patients. • On univariable Cox regression analyses, ethnicity was not significantly associated with either RFS (P= 0.231) or CSS (P= 0.752). • On multivariable Cox regression analyses that adjusted for the effects of age, gender, surgical type, T stage, grade, tumour architecture, presence of concomitant carcinoma in situ, lymphovascular invasion, tumour necrosis, and lymph node status, ethnicity was not associated with either RFS (hazard ratio [HR] 1.1; P= 0.447) or CSS (HR 1.0; P= 0.908). CONCLUSIONS • There were major differences in the clinico‐pathological characteristics of Caucasian and Japanese patients. • However, RFS and CSS probabilities were not affected by ethnicity and race was not an independent predictor of either recurrence or cancer‐related death.